 Good day, everybody. This is Dr. Sanjay Sanyal, Professor of Department Chair. So this is a supine cadaver. I'm standing on the right side, and the camera person is on the left side. We have completely e-viscerated the liver of this cadaver, and take a close look at how the liver is. First of all, it is enlarged. Secondly, it is firm, and it is congested with bile. This is the case of end-stage liver disease in this particular cadaver. And what you see here, this is the phasiform ligament, which is attached to the groove between the anatomical right lobe and the anatomical left lobe. This is the round ligament of liver, and it contains in its free margin, it contains the paramedical vein. And if you turn this, we can see that this gallbladder is highly stained with bile, and everything is bile stained. This is the region of the portahepatus, and we can see this is the cut portion of the portal vein. This is the cut portion of the common hepatic duct. This is the gallbladder fossa, from where we have separated the gallbladder, and this is the cystic artery. This whitish structure that we see here, this is the condensation of areolar tissue, which is called the cystic plate. Now I'm going to keep this aside, and I'm going to show you this is the diodenum, and we can see it is also stained with bile. This is the remnant of the common bile duct, which is entering through the head of the pancreas, which we have opened out. This is the sea loop of the diodenum, this is the head of the pancreas. This is the rest of the pancreas, and this is the spleen. The spleen in this category was relatively normal, and we can see the consistency, feel, look, size is quite normal. And these are the spleenic arteries in the spleenic veins. We can see the spleenic arteries tortures, and the spleenic vein is running behind the pancreas. Now I'm going to put this aside also, and we're going to show the rest of the posterior abdominal structures. We can see these structures here. This particular cadaver had something which is rather unique. Normally the inferior vena keva, which is this one here, it's supposed to enter into the liver, and thereafter it is not supposed to be visible. Inside the liver itself, it should pierce through the central tendon of the diaphragm, and should go into the right atrium of the heart. But here we can see that the inferior vena keva was separate from the liver, and we can see it was going continuously right up to the cable hiatus in the diaphragm. These are the fibrosis thrombos structures which were present inside the inferior vena keva. That's one thing we notice. Before I go into the details of the other structures, I will just give you a quick overview. Take a look at this reflected anti-abdominal wall, and take a look at this sheet here. This is the parietal peritoneum. Parietal peritoneum is shiny. It's composed of mesothelial cells. Same thing we see on this reflected portion also. This is the parietal peritoneum, and this is the extraperitoneal fat. The same parietal peritoneum continues onto the posterior abdominal wall on all the sites, and we can see the same thing here. So therefore, what we see here is the parietal peritoneum, which covers, that's the first structure which is covering the integer of the abdominal cavity. Once we reflect the parietal peritoneum on this side, on the right side, we see this next layer here. This is the anterior layer of the renal fascia. That's the gerotas fascia. This is the right kidney. In between the two, we can see this fat layer. So this is the extraperitoneal fat of the posterior abdominal wall. This side, we have removed the same thing, and we can see remnants of the extraperitoneal fat here. Here, we have kept the three layers. Again, to repeat, this is the parietal peritoneum. This is the anterior layer of gerotas fascia, and in between the two is the extraperitoneal fat. Now, let's come to the structures that we can see specifically here. We can see this structure here. This is the east of Vegas, and we can see it is passing through the east of pageal hiatus. That's the east of Vegas here. This is the anterior Vegas, and this is the posterior Vegas. We have also removed not only the east of Vegas, but we have also kept a cuff of the stomach here from the lesser curvature. So this is the whole structure that we see here. We have cleaned out the visceral peritoneum that is the serosa from here. The next structure that we can see here is this. This is the celiac trunk, which arises from the abdominal leotard at the level of T12. And we can see it's giving three branches. The three branches are the largest branches, this one. From the direction itself we can make out, this is the splenic artery. This is the one which goes towards the left. This is the second largest. This is the common hepatic artery, which will go towards the liver as the hepatic artery proper. And the smallest branch is this one here. This is the left castric artery. So these are the three branches of the celiac trunk. Earlier this was completely enclosed by the celiac plexus of nerves, which we have completely removed. Additionally, this one, this is the branch to the left of the diaphragm, which we can see coming from the celiac trunk. Now let's come to the next artery. This one here, this is the superior mesentery artery, which is the artery of the mid-gut. Celiac trunk is the artery of the foregut. This arises at the level of L1. And we can see it is giving these numerous branches. It gives branches to the mid-gut. This is the heliocolic. These are the helial branches. These are the gingeral branches. And these openings that we see here, there are two openings. We can see one opening here, and we can see another opening here. These are the openings of the middle colic artery and the inferior pancreatic arterial artery that we have removed from here. Once we reflect the superior mesentery artery, we can see a vein going under that. This is a very important and radical structure. This is the left renal vein. The left renal vein is longer than the right renal vein. It is located exactly between the angulation of the superior mesentery artery and the aorta. If the angle between the superior mesentery artery and the aorta is less than 25 degrees, then it can potentially obstruct the left renal vein, and that is known as left renal vein entrapment syndrome, also known as nutcracker syndrome, something like this. If this is the aorta, if this is the superior mesentery artery, left renal vein runs like this, and it can get potentially entrapped. The superior mesentery artery was also crossing the third part of the duodenum, but that we have removed. Since we are talking of the aorta, now is the right time to show you the aorta. This pink color structure that we see here, this is the aorta. And we can see arising from the aorta is one more unpaid visceral branch. This arises at the level of L3. This is the inferior mesentery artery, and we can see it is giving branches which went to the descending colon. This is the sigmoin artery, this is the left colic artery. And after that, the continuation of this inferior mesentery artery goes into the pelvis, and it becomes known as the superior rectal artery. And this was accompanied by superior rectal vein, which continued up and became known as the inferior mesentery vein, which we have removed and kept at the side here. Here is the bifurcation of this aorta that we can see here. This is the right common aliex, this is the left common aliex. And we can see, if we feel this aorta, we can feel a slightly crunchy feel. This is actually because of medial calcification of the duodenum media of the aorta. The next structure that comes to a view is this one here. This blue structure is the inferior vena kiva, which is located to the right of the aorta. And I already mentioned it, normally it should enter into the liver, but in this case, it is completely separate from the liver, and it is piercing through the cable hiatus at the level of T8. We can see this is the left renal vein, which I already mentioned, which is opening into the inferior vena kiva, and this is the right renal vein. That brings me to a few other structures. We can see this bluish structure here. This is the gonadal vein. On the right side, the gonadal vein opens into the inferior vena kiva. Here on the left side, the gonadal vein does not open into the inferior vena kiva. This is the gonadal vein. Instead, it opens into the left renal vein, and we can see that here. This is the gonadal vein, which is opening into the left renal vein. The left renal vein also receives this vein here. This is the left supra-renal vein, which opens into the left renal vein, and it also communicates with the left inferior-friendly vein, which then opens into the inferior vena kiva. That's what we see here. we see here and of course we can see the two kidneys these kidneys as I said are covered by the renal fascia and the extra-peritoneal fat anteriorly. We shall give more details about the kidney in a separate dissection and not to forget these are the ureters that are coming this is the right ureter and on this side we have not yet dissected out the left ureter and peeping through the fascia and the peritoneum we can see this muscle here this is one of the muscles of the posterior terminal wall this is the so-us major muscle but we shall also dissect it out in more detail in another dissection now let's mention a few clinical correlations this posterior terminal wall is the one which continues into the pelvis here these are the paracolic gutters so if there's any extra fluid collection in the peritoneal cavity like for example in peritonitis or acitis the fluid will always track down like this to the peritoneal cavity through the paracolic gutters when the liver was here this space where my hand is located right now this space is called the hepatorenal recess or the moistened pouch this is also a very deep recess where fluid can collect when the patient is recumbent the peritoneal cavity the retroperitoneal structures as you can see there's got a lot of fat so therefore retroperitoneal liposarcoma is a well-described entity where fat here can undergo malignant change and can become what is known as liposarcoma in earlier days when people used to use ergot alkaloids for migraine like for example methisergy as an adverse reaction to that there is to be something called retroperitoneal fibrosis the structures in the retroperitoneal aspect is to get fibrosis that is to produce uretric obstruction it is to pull the ureters medially and can could lead to uretric obstruction but nowadays of course there are very few people hardly anybody uses methisergy or ergot alkaloids for migraine another condition that affects the retroperitoneal structures is advanced cirrhosis when there is portal hypertension the retroperitoneal veins they get encouraged because they also provide a site of portasystemic communication especially the retroperitoneal aspects of the sending colon and the retroperitoneal aspect of the descending colon so therefore engorgement of the retroperitoneal veins is also a condition which is seen in advanced portal hypertension which occurs in cirrhosis and before I conclude I would like to draw your attention to this structure here where my hand is moving and this structure here this is the diaphragm the right dome in the left dome of the diaphragm which are covered by the peritoneum and under that will be the endoabdominal fascia so these are the structures that we wanted to show you in the posterior abdominal wall after removing all organs thank you very much for watching the Fussanger Sanyal signing out set is the camera person if you have any questions or comments please put them in the comment section below have a nice day please like and subscribe